Arriola Kimberly Jacob, Barrett D'Jata, Pastan Stephen, Perryman Jennie P, DuBay Derek, Di Mengyu, Teunis Larissa, Taber David, Merken Tatenda Mangurenje, Sapp Candace, Patzer Rachel E
Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
J Racial Ethn Health Disparities. 2025 Jan 9. doi: 10.1007/s40615-024-02229-0.
African Americans (AAs) with end-stage kidney disease (ESKD) experience significant barriers to accessing living donor kidney transplantation (LDKT), largely due to individual and systemic factors, including a lack of trust in healthcare systems resulting from a legacy of and continued experiences with medical racism. This cross-sectional study analyzed survey data from 416 AA patients with ESKD undergoing transplant evaluation in 2019-2023 at two kidney transplant centers in the Southeast United States, examining whether trust (specifically trust in kidney doctors, hospitals, and healthcare) modifies the relationship between attitudes towards LDKT and behavioral intentions to discuss LDKT with family and friends. Multivariable analyses revealed significant interactions. The regression model including attitudes and trust in kidney doctors was statistically significant (R = 0.114, F(7, 368) = 6.779, p ≤ 0.001). It was found that attitudes toward LDKT (β = 0.297, p ≤ 0.001) and trust in kidney doctors (β = 0.132, p = 0.008) were significantly associated with behavioral intentions to discuss LDKT with a family member or friend. Trust in hospitals, trust in the healthcare system, nor the interactions between attitudes and trust variables were significantly associated with behavioral intentions. Our findings support positive relationships between attitudes, trust in one's kidney doctor, and behavioral intentions to pursue LDKT, which have important implications for interventions that seek to improve access to LDKT among AA patients with ESKD.
患有终末期肾病（ESKD）的非裔美国人（AAs）在获得活体供肾移植（LDKT）方面面临重大障碍，这主要归因于个人和系统性因素，包括由于医疗种族主义的历史遗留问题和持续经历而对医疗系统缺乏信任。这项横断面研究分析了2019年至2023年期间在美国东南部两个肾脏移植中心接受移植评估的416名患有ESKD的非裔美国患者的调查数据，研究信任（特别是对肾脏医生、医院和医疗保健的信任）是否会调节对LDKT的态度与与家人和朋友讨论LDKT的行为意图之间的关系。多变量分析显示了显著的相互作用。包括对肾脏医生的态度和信任的回归模型具有统计学意义（R = 0.114，F(7, 368) = 6.779，p≤0.001）。研究发现，对LDKT的态度（β = 0.297，p≤0.001）和对肾脏医生的信任（β = 0.132，p = 0.008）与与家庭成员或朋友讨论LDKT的行为意图显著相关。对医院的信任、对医疗系统的信任以及态度与信任变量之间的相互作用均与行为意图无显著关联。我们的研究结果支持了态度、对自己肾脏医生的信任与寻求LDKT的行为意图之间的积极关系，这对于旨在改善患有ESKD的非裔美国患者获得LDKT机会的干预措施具有重要意义。
